A – 20 Ethnic Differences in the Predictive Utility of Delayed Primacy Recall for Cognitive Impairment in the Health & Aging Brain Study

Objective Delayed recall regional primacy, part of the serial position effect (SPE), is a promising early cognitive marker for Alzheimer’s disease (AD). However, its predictive value across racially and ethnically diverse populations remains unclear. This study examined whether delayed primacy recall from the Spanish-English Verbal Learning Test (SEVLT) predicts cognitive impairment similarly across racial/ethnic groups. Method Data were drawn from the Health & Aging Brain Study – Health Disparities (HABS-HD), a community-based cohort of older adults. Participants (N = 2,159) were classified as cognitively unimpaired (n = 1,664) or impaired (n = 495). Delayed recall regional primacy scores were derived from SEVLT performance. Logistic regression examined whether recall predicted impairment and whether this relationship varied by ethnicity (Black, Hispanic, White), with interaction terms included. Demographic comparisons revealed that White participants (n = 956) were older (x- = 68.82) and had higher education (x- = 15.64 years) than Black (n = 281; x- age = 62.90; x- edu = 15.26) and Hispanic participants (n = 922; x- age = 63.40; x- edu = 9.83). Results Delayed recall regional primacy significantly predicted lower odds of impairment overall (Estimate = -5.27, p < .001). However, the relationship was significantly weaker for Black (Estimate = 2.84, p < .001) and Hispanic (Estimate = 1.44, p = .006) participants compared to White participants. Conclusion Delayed primacy recall is a useful cognitive marker, but its predictive utility differs across ethnic groups. These findings emphasize the need for culturally sensitive cognitive screening tools to support equitable early detection of AD.